Measles elimination in Cuba

The persistence of measles outbreaks in countries with high vaccination coverage suggests that a single dose of vaccine may be insufficient to eliminate measles. Cubas first strategy during 1971-79 involved vaccination of children 6 months to 5 years old in the primary health services. Continuing outbreaks led to a second strategy during 1980-85 involving vaccination of children 9 months to 14 years old. Average coverage was 77.5% during the period but transmission continued. The current strategy has three essential components. To increase population immunity rapidly and reduce the chain of transmission a single national campaign was conducted for all children 1-14 years old regardless of vaccination or illness history. Basic vaccination services were reinforced to provide a minimum of 95% coverage at 1 year. Finally periodic large scale campaigns are conducted for children 2-6 years old regardless of vaccination and illness history. During the first catch-up campaign from October 1986 to March 1987 nearly 2.5 million children were vaccinated and coverage was estimated at 97.6%. Nearly 900000 children 2-6 years old were vaccinated in a follow-up campaign in November 1993 with coverage estimated at 98%. Coverage of routine vaccination of children at 1 year averaged 98% between 1988 and 1996. The last serologically confirmed measles case was reported in 1993.